1. 2 the national center on homelessness among veterans …. to promote recovery oriented care for...
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The National Center on Homelessness Among Veterans
The National Center on Homelessness Among Veterans
….to promote recovery oriented care for Veterans who are homeless or at-risk for homelessness.
The primary goal of the Center is to develop, promote, and enhance policy, clinical care research, and education to improve homeless
services so that Veterans may live as independently and self-sufficiently as possible in a community of their choosing.
• The Center was awarded in May 2009• Co-located at Philadelphia VAMC and Tampa VAMC• Academic Partners:
• University of Pennsylvania • University of South Florida
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Policy Analysis
Model Development
Education
Research
Center StructureCenter Structure
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Center PersonnelCenter Personnel
• Vince Kane, MSW - Center Director• Roger Casey, PhD - Deputy Director• Dennis Culhane, PhD - Director of Research• Steve Metraux, PhD - Associate Director of
Research, Philadelphia• Robert Rosenheck, MD - Associate Director• Roger Peters, PhD - Investigator • John Kuhn, MSW, MPH - Investigator• Colleen Clark, PhD - Associate Director of
Research, Tampa
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New Directions (Role of the Center)New Directions (Role of the Center)
• Focus on the what works – When?– With Who?
• How do we get to Zero homelessness among Veterans and keep it there?
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Focus of Research to DateFocus of Research to Date
• Last 20+ years
• Why are there homeless Veterans (epidemiology)?
• How effective are the programs?
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Percentage of veterans among homeless and domiciled US males in 1996: by age group
15%
60%
47%
34%
46%
63%
49%
38%
14%
8%
0%
20%
40%
60%
20-34 PostVN ('82 - )
35-44 PostVN ('73-'81)
45-54 (VN) 55-64 (Korea-VN)
>64 (WWII +Korea)
Pe
rce
nta
ge
of
Ve
tera
ns
HomelessDomiciled
From NSHAPC, 2000 and CPS, 1996
O.R =2.0 O.R =3.2 O.R 1.4 O.R =.89 O.R =.88
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Percentage of veterans among homeless1 and domiciled US women in 1996
3.12%
1.27%
0%
1%
2%
3%
4%
5%
6%
All US Women
Pe
rce
nta
ge
of
Ve
tera
ns
HomelessDomiciled
1. Community sample from NSHAPC; CPS, 1996
Odds Ratio = 3.6
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Percentage of OIF/OEF veterans among all homeless1
and domiciled veterans (2007)
1.30%
4.00%
0.00%
2.50%
5.00%
OIF/OEF VeteransPe
rec
en
tag
e o
f O
IF/O
EF
Ve
tera
ns
HomelessDomiciled
Odds Ratio = 0.39
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Do veterans think their homelessness is associated with military service?
Do veterans think their homelessness is associated with military service?
• On average, homeless Veterans became homeless 12.5 years AFTER discharge from the military.
• When asked “Did military service increase your risk of homelessness?”– No 59%– Somewhat 25%– Very much 16%
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Clinical OutcomesClinical Outcomes
• VA has evaluated outcomes of over 4,500 homeless Veterans in nine different program initiatives.
• Follow-up durations of 8 months to 5 years
• Typically, 70% - 80% are housed 1 year after program entry or discharge.
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Outcomes in the HUD-VA Supported Housing Program:Percentage of Days Housed in Past 60 days
0
20
40
60
80
100
Baseline 6 mos. 1 year 18 mos. 2 years 3 years
% D
ay
s H
ou
se
d i
n P
as
t 6
0 D
ay
s
VASH exp. : N=182
Case mgt. N=88
Std. care: N=187
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Outcomes in the HUD-VA Supported Housing Program:Percentage of Days Homeless in Past 60 days
0
10
20
30
40
50
Baseline 6 mos. 1 year 18 mos. 2 years 3 years
% D
ays
Ho
mel
ess
in P
ast
60 D
ays
VASH exp. : N=182
Case mgt. N=88
Std. care: N=187
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Outcomes in the HUD-VA Supported Housing Program:Days of Alcohol Use in past 30 days
0
2.5
5
7.5
10
Baseline 6 mos. 1 year 18 mos. 2 years 3 years
Da
ys
of
Alo
co
ho
l U
se
in
Pa
st
30
Da
ys
VASH exp. : N=182
Controls
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Days Competitive Employment in Supported Employment (IPS) [Adjusted Means (Rosenheck and Mares 2008)]Days Competitive Employment in Supported Employment (IPS) [Adjusted Means (Rosenheck and Mares 2008)]
0
2
4
6
8
10
12
bl 3-mo 6-mo 9-mo 12-mo 15-mo 18-mo 21-mo 24-mo
IPS
Control# D
ays
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4 45 5
1011 11
13
4
6 6 67
87 7
0
5
10
15
Year - 4 Year - 3 Year - 2 Year - 1 Year + 1 Year + 2 Year + 3 Year + 4
Year Before (-) or After (+) Program Initiation
Per
cen
t R
ecei
ved
Ben
efit
s
Joint Outreach Sites Comparison Sites
SSA-VA Joint Outreach: Rates of Award Among All Outreach Veterans (N=34,431)
Intervention
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New Directions (short list)New Directions (short list)
• Update and Expand Epidemiologic Studies
• Improve Clinical Outcomes: Evaluate Smoking Cessation (80% currently smoke)
• Test Computerized Psychotherapy for Substance Abuse
• Evaluate Traumatic Brain Injury Among Homeless Veterans
• Justice Outreach/Jail Diversion
• Test New Case Management Models
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Goals of Initial Research Projects in the Center
Goals of Initial Research Projects in the Center
• Fine-tune program targeting by geographic regions and demographic groups
• Improve effectiveness of VA homeless programs
• Improve coordination between VA and non-VA homeless services
• Develop prevention-oriented system for returning Veterans
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Multi-Site Prevalence StudyMulti-Site Prevalence Study
• Based on Homeless management Information System (HMIS) and VA data from 10 jurisdictions across US
• Compares prevalence of homelessness among Veteran and general populations
• Identifies demographic groups (gender, age, race, poverty) among Veterans that are at highest risk for homelessness in multiple jurisdictions
• Supports targeting decisions
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AHAR SupplementAHAR Supplement
• Annual Homeless Assessment Report • AHAR Supplement:
– Same format as AHAR– Focus is exclusively on Veterans– Can provide estimates of Veterans who use
mainstream homeless services– Data available for two-thirds of the CoC’s in the US;
first national data since 1996– Due out: October/November 2010
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Services Utilization ResearchServices Utilization Research
• Based on matching data on homeless Veterans and records of other services
• Data matches may include:– Homeless services (VA & Non-VA)– Health & Mental Health Services (VA & Non-VA)– Criminal Justice
• Addresses questions related to:– Mainstream services use by homeless Veterans– Overlaps between VA and non-VA services– Costs and cost offsets
• Goal: Improved Coordination between VA and Non-VA services
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Veterans Affairs Supportive Housing (VASH)
Veterans Affairs Supportive Housing (VASH)
• Use VASH to build an evidence base for effective supportive housing models
• Evaluate different housing & case management configurations
• Case management (CM) dynamics:– Intensity & duration of case management regimens– Start points and tapering schedules– Types of services provided in conjunction with CM– Peer support– Substance Abuse– Fidelity
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Homelessness Among Returning OEF/OIF Veterans: Risk Resiliency Study
Homelessness Among Returning OEF/OIF Veterans: Risk Resiliency Study
• Follows a cohort of returning OEF (Afghanistan) and OIF (Iraq) veterans to determine factors contributing to risk of homelessness
• Detailed data from induction & discharge interviews (DoD) and homeless data (VA)
• Builds on VA homelessness research from previous eras
• Rich data on circumstances of Veterans to link with subsequent homelessness
• Data will inform the design of prevention efforts
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Evaluating Housing Programs for Homeless Veterans
Evaluating Housing Programs for Homeless Veterans
In order to determine the best match of Veterans housing and housing services, this study will:
• Evaluate community-based housing services• Define key features of the housing and
associated services• Determine criteria that measure these features• Conduct assessments to describe the housing
options
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Evaluation of Housing and Housing Services Study
Evaluation of Housing and Housing Services Study
Program Characteristics
1.00
1.50
2.00
2.50
3.00
3.50
4.00
4.50
5.00
Obtaining
Housing
Housing-related
Services
Linkages forServices &Resources
Organizational
Climate
Staff -Consum
erInteraction
Host AgencyCharacteristics
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TBI in the Homeless Veteran PopulationTBI in the Homeless Veteran Population
Demographic Data of Homeless Veterans with TBI:
• 22% of casualties of returning Veterans (Institute of Medicine, 2008)
• 59% of admissions to Walter Reed between January ‘03 – February ‘05 (Institute of Medicine, 2008)
• 33% of subjects diagnosed with substance use disorders had indications of TBI (Walker et al, 2008)
• 77% of homeless Veterans seen in VA Homeless Programs had a primary or secondary diagnosis of Substance Use Disorder (NEPEC, 2008)
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TBI in the Homeless Veteran PopulationTBI in the Homeless Veteran Population
• Examine national prevalence
• Formulate education and training for VA and community-partner staff
• Develop and implement models of case management, housing support services and residential treatment
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TBI in the Homeless Veteran PopulationTBI in the Homeless Veteran Population
The study is integral to the Center’s goal of examining the homeless Veteran population to:
• Further understand the population and needs
• Develop evidence-based training and programs that will enhance current services
• Work toward ending homelessness among Veterans
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Homeless Veterans in the Criminal Justice System
Homeless Veterans in the Criminal Justice System
• 15-16% of jail inmates are homeless, including significant numbers of Veterans
• 30-39% of homeless inmates have a mental health disorder
• 78% of this group have substance use disorders
• More likely to have violent charges, held in jail longer, rapid cycling, high utilizers of services
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Homeless Veterans in the Criminal Justice SystemHomeless Veterans in the Criminal Justice System
Implications-Interventions-Research:
(1) Early identification/screening in justice settings
(2) Training (law enforcement, courts, jail, probation)
(3) Triage and diversion
(4) Coordination and linkage with VA services
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Veteran’s Justice System InvolvementVeteran’s Justice System Involvement
• First phase: comprehensive survey of the structure and function of the Veterans Justice Outreach Specialists (VJO Specialists) at all 153 VA Medical Centers.
• Second phase: utilize this information for a study where various elements of the VJO specialist positions will be studied in relation to a variety of outcomes.
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